Longer Length of Stay and Higher Hospital Charges for Status Asthmaticus in Children with Comorbid Psychiatric Disorders

Abstract

Rationale: Asthma is one of the most common chronic disorders of childhood and is associated with significant healthcare utilization and costs. Comorbid psychiatric disorders, specifically depression and anxiety, are more prevalent in patients with asthma and are associated with worse asthma control, more emergency room visits, and increased hospitalization rates. The aim of our study was to compare hospital outcomes and charges for children with status asthmaticus with and without comorbid depression and anxiety. Methods: Retrospective review of the 2000-2012 Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Databases (KID). The databases were queried for admissions of patients aged 10-21 years old with an ICD-9 code for status asthmaticus (493.01, 493.11, 493.21, 493.91) or any asthma (493 and non-status asthmaticus subcodes) with a procedure code for endotracheal intubation (96.02 or 96.04), to capture all admissions for severe asthma. Two subgroups were created for admissions with ICD-9 codes for depression (296 and subcodes) or anxiety (300 and subcodes). Data collected included demographics, hospital outcomes and charges. The depression and anxiety groups were compared to admissions with no ICD-9 code for any neuropsychiatric disorders using independent samples Kruskal-Wallis test with Bonferroni correction and χ 2 , as appropriate. Results: There were 52,485 admissions with status asthmaticus, 45,094 (86%) with no neuropsychiatric disorders, 1,284 (2.4%) with depression, and 1,297 (2.5%) with anxiety. Demographics, hospital outcomes and charges are in Table 1. Admissions with either depression or anxiety were older, had a longer length of stay and had higher hospital charges (p<0.001 for all). There was a higher in-hospital mortality rate for the depression group. Conclusions: A comorbid diagnosis of depression or anxiety is associated with a longer length of stay and higher hospital charges for status asthmaticus in children. These findings suggest that screening for and management of comorbid psychiatric disorders in this population could improve hospital outcomes.